A case of pyogenic spondylitis mimicking spinal invasion of lung cancer diagnosed by open thoracotomy

Abstract

A 42-year-old man visited our hospital with the chief complaint of chest pain. Chest CT showed bone destruction of the thoracic vertebra, which was adjacent to a lung nodule under the right lung, S6 pleura, that appeared to be lung cancer with spinal invasion. Thoracoscopic needle biopsy of the lung nodule was performed, but it did not lead to a diagnosis of lung cancer and a definitive diagnosis was not possible. We considered that more biopsy specimens were necessary, and removed the pulmonary nodule and paraspinal column organization, which adhered to each other, en bloc during posterolateral open thoracotomy. The histopathological diagnosis was not lung cancer but abscess formation by Staphylococcus aureus due to pyogenic spondylitis. When we doubt lung cancer with spinal invasion, pyogenic spondylitis should always be considered as an important disease as part of the differential diagnosis.